Patients' tsar slams Government for ageism

The Government's patients' tsar Harry Cayton has condemned the NHS for creating a culture of ageism with the widespread use by staff of demeaning language to describe the elderly.

He says terms like "crinklies", "crumblies" and "bed blockers" should be outlawed from the workplace in the same way as derogatory racist and sexist words are.

Mr Cayton, who is the Department of Health's national director for patients and the public, also cites "frequent flyer" as someone who regularly enters hospital and 'dement' for an Alzheimer's disease victim as other examples of the way older patients are "dehumanised".

He said: "It is interesting to note that this language is most commonly used about older people. Older people generally use the health service most often but they are also sometimes the least able to speak up for themselves, the most vulnerable. Maybe the embedded ageism in society allows these terms to be more acceptable."

In an editorial in the Journal of the Royal Society of Medicine, he says some of the language used in the health service shifts blame to patients.

Mr Cayton said: "We cannot create a patient-centred health system unless we change the language we use. Language is at the centre of the relationship between patients and medical professionals and how we talk to and about patients is crucial."

He went on: "My attention was drawn to this recently by the emergence in the media and in management speak of the term 'frequent flyers' to describe those frail, mainly older people who come in and out of hospital on a regular basis.

"The term 'frequent flyer' in this context is demeaning, trivializing and of course plain wrong. It implies that somehow these people want regular trips to hospital, that they are collecting points, that they enjoy the health and life threatening roundabout of continual admission, treatment and discharge.

"The health service uses language in this way to shift the blame. By using 'frequent flyer' we imply that patients are acting out of choice whereas of course people who are forced to attend hospital too frequently are a sign of our failure.

"'Bed blockers' is another alienating term which shifts the blame from the NHS to the patient as, in its different way, is the reduction of all of us who don't turn up for appointments to 'DNAs'. Categorizing people as DNAs allows the service to avoid looking at why its appointment system does not work.

"It is not surprising some of us become DNAs. Labelling people in this way is the most common way in which the NHS dehumanises those it is supposed to care for.

"As well as notorious terms such as 'crinklies' and 'crumblies' sometimes used in geriatric wards, people are also reduced to no more than their condition; 'We have two hips and a knee in today' in the surgical ward or the diminution of a human being with Alzheimer's disease to no more than a 'Dement'."

Mr Cayton said: "This is not a matter of political correctness gone mad, but we must not dehumanise patients. Hospital managers and professionals in clinical care have a responsibility to their patients which must include courtesy. "The health service must challenge those not using appropriate language in respect of patients in the same way that racist or sexist language is not tolerated.

"Language reflects and shapes our thinking and therefore our behaviour. The NHS has a long way to go before patients and customers are treated with the respect they deserve." Mr Cayton added: "I can understand in the stressful environment of health care, when you are working close to pain and disease and possibly death, you need some distance. This language establishes distance by turning people into objects. But there are other, kinder ways of achieving detachment and, yes, language does matter.

"Language both reflects and shapes our thinking and thus our behaviour. Discourtesy cannot be the basis on which a healing relationship is built. The reduction in sexist and racist language has not eliminated sexism and racism but it sets a context and an environment in which sexism and racism are more shocking and tolerated less.

"We must do the same with the language of blame and disrespect. We are a long, long way from patient-centred health care and our language betrays us." Dr Kamran Abbasi, editor of the Journal of the Royal Society of Medicine, said it was the responsibility of senior doctors to stamp out the practise.

He said: "The culture of the NHS is such that language and behaviour are learnt from senior clinicians. It is their responsibility to ensure that clinical teams mind their language.

"Some people will say that this is irrelevant to clinical care, but as soon as you start using inappropriate terms to describe patients you cease to see them as human beings. Modern healthcare requires greater sensitivity towards patients."

Mr Cayton advises ministers, the Department of Health and the NHS on the involvement of patients and the public, on improving patients experience and on building a patient centred health service.

He took up his role in May 2002 on a part time secondment from the Alzheimer's Society and joined the Department as Director for Patients and the Public in September 2003.

He continues to work one day a week in the voluntary sector to keep in touch with service users' issues and priorities.